Safety for Recovery During Admission to Acute Mental Health Hospitals: A Constructivist Grounded Theory Study to Support Safety-Focused Recovery-Oriented Care in the Context of Risk Management Constraints

Recovery during admission to acute mental health hospitals can involve supporting individuals in beginning to work towards a fulfilling life despite experiencing mental distress. This can help reduce risks such as suicide and aggression. However, restrictive risk management practices, such as physical restraint may increase during this period, and the distress caused by these practices can hinder a person's abilities to understand their recovery needs. Little is known about how recovery can occur safely within the context of such risk management restrictions. Therefore, this constructivist grounded theory study explored the perspectives of 15 individuals with hospital admission experiences about how they might begin their recovery journeys amidst these constraints. The study found that people could reconnect with their beliefs about a fulfilling life vicariously through interpersonal relationships. This facilitated a sense-making process allowing individuals to better understand their recovery needs which were otherwise obscured by the complexity and intrusiveness of risk management practices. The theory comprised of four social processes: ‘treating me safely,’ when nurses began to understand those admitted as individuals; ‘outside world inside,’ which involved nurses helping the person to form meaningful connections to their personal world; ‘tangible hopefulness,’ where nurses raised the person's awareness of meaningful successes; and ‘scaffolding recovery,’ which built on the previous three processes, with the nurses helping individuals recognise the potential for working towards a fulfilling life. The study shows how supporting a relational approach to care may lessen people feeling unsafe when admitted to hospital, despite experiencing potentially distressing risk management practices.